Provider Demographics
NPI:1982178356
Name:ELROD, ANGELA MARGARET
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARGARET
Last Name:ELROD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16480 SILVER LANDINGS
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-8001
Mailing Address - Country:US
Mailing Address - Phone:810-623-6129
Mailing Address - Fax:
Practice Address - Street 1:16480 SILVER LANDINGS
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-8001
Practice Address - Country:US
Practice Address - Phone:810-623-6129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty